College of Nurses of Ontario v. Susan Collins, 2006 ONCNO 81750

PANEL: Lori McInerney, RN Chairperson Cheryl McMaster, RPN Member Kendra O’Bryan, RPN Member Faira Bari Public Member Linda Bracken Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) CAROLINE ZAYID for ) College of Nurses of Ontario

and - )

SUSAN COLLINS, RN ) SHEILA RIDDELL for Registration No. 9518119 ) for Susan Collins

) Heard: June 14, 2006

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on June 14, 2006 at the College of Nurses of Ontario (the “College”) at Toronto.

The Allegations

College Counsel informed the panel that allegation(s) #1d, 3e have been withdrawn. Consequently, the hearing proceeded in relation to the following allegations against Susan Collins RN (the “Member”), as stated in the Notice of Hearing dated March 22, 2006.

You have committed an act of professional misconduct, as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S. O. 1991, c. 32, as amended, and defined in paragraph 1.01 of Ontario Regulation 799/93, in that, while employed by [the Agency] as a casual visiting Registered Nurse, you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession in that you, between the dates of April 20, 1995 and December 11, 2003:

(a) failed to appropriately and completely document client contacts, contrary to the reporting requirements of [the Agency];

(b) failed to return client discharge charts following their discharge from your care;

You have committed an act of professional misconduct, as provided by subsection 51 (1) (c) of the Health Professions Procedural Code of the Nursing Act, 1991, S. O. 1991, c. 32, as amended, and defined in paragraph 1.08 of Ontario Regulation 799/93, in that, while employed by [the Agency] as a casual visiting Registered Nurse, you misappropriated property from your workplace, more specifically, you billed, and were paid, for 9 visits not made by you to [the client] between October 1, 2003 and December 2, 2003.
You have committed an act of professional misconduct, as provided by subsection 51 (1) (c) of the Health Professions Procedural Code of the Nursing Act, 1991, S. O. 1991, c. 32, as amended, and defined in paragraph 1.37 of Ontario Regulation 799/93, in that, while employed by [the Agency] as a casual visiting Registered Nurse, you engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all of the circumstances, would reasonably be regarded by Members as disgraceful, dishonourable or unprofessional, in that you:

(a) misappropriated property from your workplace, more specifically, you billed for 9 visits not made by you to [the client] between October 1, 2003 and December 2, 2003;

(b) failed to appropriately and completely document client contacts, contrary to the reporting requirements of [the Agency];

(d) failed to maintain client charts at their respective residences.

Member’s Plea

Susan Collins admitted the allegations set out in paragraphs numbered 1a,b,c 2 and 3a,b,c,d in the Notice of Hearing. The panel conducted a plea inquiry and was satisfied that the Member’s admission was voluntary, informed and unequivocal.

Agreed Statement of Facts

Counsel advised the panel that an Agreed Statement of Facts had been entered into by the parties. The Agreed Statement of Facts was filed as an exhibit and is set out below:

THE MEMBER

The Member, Susan Collins (“Ms. Collins” or “the Member”), graduated from the RN Diploma Program from [ ] in 1994 and has been registered with the College of Nurses of Ontario (“the College”) since 1995.
Ms. Collins commenced work with [the Agency] on April 20, 1995 as a casual visiting RN, and worked simultaneously at [a] College.
Ms. Collins’ employment with [the Agency] terminated as of December 11, 2003.
Ms. Collins is currently employed as a nurse by [ ], where she is engaged in telephone nursing practice.

THE EMPLOYER

[The Agency] is an agency providing all levels of home care services, including nursing care, home support, occupational therapy, speech-language pathology and physiotherapy. Visiting nurses report directly to [the Centre], are hired individually on a casual basis, and share clients. The program in [ ] averages 300 visits per week for 15-20 nurses.
[The Agency] was often short staffed and for most of her employment, Ms. Collins worked at least 40 hours per week at the employer’s request. In addition to these hours, Ms. Collins traveled extensively for her work due to the large geographic area she served.

INADEQUATE DOCUMENTATION

Between March 2001 and October 2003, while working as a visiting nurse, the Member repeatedly failed to make and maintain appropriate records concerning the nursing care she provided to clients. In particular she:

(a) failed to provide nursing reports to the appropriate [Centre] case manager concerning her assessments of the client’s condition

(b) failed to document visits to clients in a timely manner

(d) failed to return completed charts in a timely manner to [the Agency] upon discharge of clients.

The failures described above, made it more difficult for each client’s [Centre] case manager to adequately follow the client’s progress and to ensure that appropriate nursing resources were provided to the client.
Throughout this period of time, supervisors at [the Agency] repeatedly reminded the Member about the requirements established by the College of Nurses of Ontario in its Practice Standard for Documentation, and about the employer’s documentation requirements. Despite these reminders and instructions, the employer continued to receive complaints concerning the Member’s charting and reporting.

IMPROPER BILLING

On or about July 20, 2003, Ms. Collins was assigned as the primary nurse for [the client]. Scheduled visits were made to [the client] by Ms. Collins up to and including September 2003.
Ms. Collins billed for seven visits with [the client], namely visits on October 22 and 29, November 5, 13, 19 and 25, and December 2, 2003, when she did not in fact see the client on those dates. On certain of these dates, Ms. Collins attended at [the client’s] residence, finding her not at home. These visits should not have been billed.
Ms. Collins was paid a total of $200.20 for the visits not made by her to [the client] Between October 22, 2003 and December 2, 2003.
On December 10, 2003, the [Centre] Case Manager, [ ], called [the client] to see how she was doing and to make sure she was satisfied with the planned discharge date of December 10, 2003. During this telephone call [the client] indicated that she was surprised to hear about the December 10 discharge date and that Ms. Collins had not seen her since September 25, 2003 (the correct date was actually October 15, 2003). In light of this telephone conversation, [the Case Manager] forwarded a Reportable Events Document (“RED”) to [the Agency] indicating that Ms. Collins had been billing for visits with [the client] that had not occurred.
At the time that she improperly billed for the visits described in paragraph 11 above, Ms. Collins knew that she was not entitled to do so.

OTHER FACTORS

Following the termination of her employment at [the Agency], Ms. Collins sought a referral to a psychologist for counselling. Their intent for the counselling sessions was to discuss her tendency to accept more work than she can handle and her inability to say no.
Ms. Collins’ supervisor at [the Agency], [ ], told the College Investigator that Ms. Collins had ongoing difficulties with documentation and organization of work, but she was also a “phenomenal nurse” with excellent knowledge, and was well liked by her clients.

ADMISSIONS

The Member admits that she failed to appropriately document client visits, and to provide reports of her nursing assessments.
The Member admits that she failed to return client charts to [the Agency] in a timely manner following their discharge from her care.
The Member admits that she failed to maintain client charts at their respective residences.
The Member admits that she charged and was paid for seven visits to [the client] which were never actually made.
The Member admits that the conduct described herein constitutes professional misconduct as alleged in paragraphs 1, 2 and 3 of the Notice of Hearing.

Decision

The panel considered the Agreed Statement of Facts and finds that the facts support a finding of professional misconduct, as alleged in paragraphs 1 a, b, c, 2 (seven visits) and 3 a, b, c, d.

Penalty Submission

Counsel for the College advised the panel that a Joint Submission as to Penalty had been agreed upon. The Joint Submission as to Penalty provides as follows:

The College of Nurses of Ontario (the “College”) and Susan Collins (the “Member”) respectfully submit that, in view of the circumstances set out in the Agreed Statement of Facts and the Member’s admissions of professional misconduct, the Panel of the Discipline Committee should make an Order as follows:

Requiring the Member to appear before the panel to receive an oral reprimand.
Directing the Executive Director to suspend the Member’s certificate of registration for one month from the date that this Order becomes final.
Requiring the Member to pay a fine of $450 to the Minister of Finance.
Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:

(a) the Member shall enrol in and successfully complete a course in nursing documentation acceptable to the College’s Director of Investigations and Hearings (“the Director”) within twelve months of the date of the Order and shall provide proof of enrolment and completion of such course to the Director;

(b) the Member shall review the College’s Standards documentation, and then meet with a College Practice Consultant to discuss the College’s Documentation Standards and Ethics, and prepare a learning plan with the Practice Consultant concerning relevant ethical standards; the results of which shall be provided to the Practice Consultant within six months of the date of the Order.

(i) only practice nursing when working for an employer, and may not practice independently;

(ii) advise the College of Nurses of Ontario of the name of her employer;

(iii) provide the decision of the Discipline Committee to any employer; and

(iv) only work for an employer who is willing to ensure that an RN will:

a) periodically monitor the Member’s practice with respect to documentation;

b) send a copy of a written appraisal of the Member’s nursing practice in relation to documentation to the Director no less than six months and no more than nine months after the date of the Order; and

c) notify the Director immediately if he/she becomes aware that the Member is not complying with College’s Standards.

Counsel for the College submitted that the penalty should address the following goals:

general and specific deterrence;
rehabilitation; and
protection of the public.

The oral reprimand and suspension will provide specific deterrence to the Member, sending a message that this conduct is serious and will not be tolerated. General deterrence will be achieved, sending a message to the profession that this conduct is not acceptable. Rehabilitation will be achieved through education and upgrading relating to documentation and ethics. Protection of the public will be achieved through the monitoring components of the penalty.

Mitigating factors included the Member’s:

heavy work load, as her employer was often short staffed;
admission of the allegations, and agreement to proceed with an agreed statement of facts and joint submission on penalty;
acknowledgement of the issues and her steps to obtain counselling; and
former employer respected her care giving abilities, and described her as a “phenomenal nurse” with excellent knowledge.

Aggravating factors included:

potential harm to clients if charting not complete;
client’s needs could be compromised relating to the failure to maintain client charts at their respective residences; and
billing for visits not made is serious, specific to honesty, integrity and trust.

The proposed fine is punitive in nature relating to costs incurred by her employer.

Counsel for the Member concurred with College Counsel’s submissions. Additionally, the Member’s counsel submitted that:

the Member did not intend to be dishonest;
billing errors occurred due to the Member’s lack of organizational skills; and
the Member has accepted responsibility for her actions.

Penalty Decision

The panel accepts the Joint Submission as to Penalty and accordingly orders:

The Member to appear before the panel to receive an oral reprimand.
The Executive Director to suspend the Member’s certificate of registration for one month from the date that this Order becomes final.
The Member to pay a fine of $450 to the Minister of Finance.
The Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:

(i) only practice nursing when working for an employer, and may not practice independently;

(ii) advise the College of Nurses of Ontario of the name of her employer;

(iii) provide the decision of the Discipline Committee to any employer; and

(iv) only work for an employer who is willing to ensure that an RN will:

a) periodically monitor the Member’s practice with respect to documentation;

c) notify the Director immediately if he/she becomes aware that the Member is not complying with College’s Standards.

Reasons for Penalty Decision

The panel concluded that the proposed penalty is reasonable and in the public interest. The Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility for her actions. The panel believes the penalty recognizes the seriousness of these acts of misconduct and provides the right balance between specific deterrence to the Member and general deterrence to the members of the profession. The panel recognizes that honesty and trustworthiness are hallmarks of the nursing profession.

I, Lori McInerney, RN, sign this decision and reasons for the decision as Chairperson of this Discipline panel and on behalf of the members of the Discipline panel as listed below:

Chairperson Date

Panel Members:

Cheryl McMaster, RPN

Kendra O’Bryan, RPN

Faira Bari, Public Member

Linda Bracken, Public Member